Indonesia rules out H5N1 case cluster in Sumatra

Aug 13, 2008 (CIDRAP News) – In an online statement posted yesterday, the Indonesian government said 12 villagers from North Sumatra who were hospitalized for suspected avian influenza symptoms had tested negative for the disease, dampening speculation about a possible case cluster.

The statement from the health ministry's avian flu committee, known as KOMNAS FBPI, was dated Aug 9, but appeared on the group's Web site yesterday. It said 12 villagers from Air Batu village tested negative for the H5N1 virus. All were being treated at Kisaran Hospital, except for a 7-year-old girl and an 8-year-old boy who were at Adam Malik Hospital in Medan, the provincial capital, where they were reported to be in stable condition.

The ministry's statement did not mention three deaths from suspicious symptoms that have been mentioned along with accounts of up to 13 sick patients in recent media reports. Yesterday, however, Chandra Syafei, an official from North Sumatra's health office, acknowledged that three people had died and said his office was on "extraordinary occurrence" alert status, according to a Jakarta Post report.

"The three people died following the discovery of dead poultry, but we don't know whether or not it [avian influenza] was the cause," Chandra told the Post. He said his office had not received autopsy reports from the health ministry.

The suspected cases were identified by provincial and local health officials between Aug 5 and 7, and the patients were given oseltamivir when they were hospitalized, the health ministry's statement said. Also, it said the ministry was conducting surveillance in the area for more patients with suspicious symptoms.

The ministry's message, its first since Jun 19, said the tests were conducted by its Health Research and Development Center. Official news out of Indonesia about H5N1 developments has been scarce since early June, when Health Minister Siti Fadilah Supari said the country would stop reporting human cases as they occur and instead announce them at longer intervals, perhaps as long as 6 months.

Syafei said several health workers, including a team from the World Health Organization (WHO), were in Asahan to investigate the illnesses and monitor developments, according to the Post report.

He said animal health officials had destroyed 276 infected birds, and an official from nearby Labuhan Ratu regency said local veterinary workers culled 1,126 birds after hundreds of recent poultry deaths, the Post reported.

The health ministry statement said tests conducted by North Sumatra's livestock office on 15 poultry that died suddenly on Jul 28 were positive for avian influenza. (The statement did not specify the subtype.)

Meanwhile, flu blogs and message boards have been following developments in what some fear could represent an H5N1 case cluster, an event that suggests the possibility of human-to-human transmission and an increased risk of a pandemic. For example, members of Flu Trackers and Flu Wiki have been translating foreign-language media reports for clues and developments, though the translations are often difficult to interpret and can be unreliable.

ProMED-mail, the Internet based reporting system of the International Society for Infectious Diseases, has also been posting media reports on the suspected case cluster and has appealed for more information on the cases and deaths. On Aug 10, after noting conflicting reports about the cases, ProMED said it would no longer report suspected avian flu cases in Indonesia until they have been confirmed by the nation's health ministry. But a protest from a reader prompted the service to say yesterday it would reconsider the decision.